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Welcome to your Best Destination: Costa Rica – both in the public as well as private fields. The health indices for Costa Rica are at the same level as those found in the United States, and are, without a doubt, the best in Latin America, better even than those found in wealthier countries such as Mexico or Argentina. Life expectancy is the highest in Latin America: at 78, it equals the life expectancy of the United States and is only passed by Canada whose life expectancy is 81 years of age. Costa Rica has first class hospital facilities, both state run and private. Add to this the fact that the country has a medical corps that is highly qualified, both nationally and internationally and covers all the medical specialties. Patients can count on a clear legal supportive environment that protects them and also provides them with the ability to take their cases to conciliation and arbitration that is executed quickly, with neutrality, and with specialization in conflicts that are based on medical issues.

Presidente Dr. Jorge Cortes Rodríguez

Faced with such an important potential market, PROMED (the Council for the International Promotion of Medicine in Costa Rica) has considered it of utmost importance to develop a product that can serve as a Guide for all tourists who come to this country to receive medical care and for all the medical insurance companies who are weighing the possibility of choosing Costa Rica as a destination for medical and dental treatments.

Every year, millions of people travel abroad looking for professional medical services. Medical tourism is no longer just a means to save money on plastic surgery; for millions of people, it has become the only solution to managing their health problems when they do not have medical insurance. Costa Rica has become, without a doubt, one of the privileged destinations for this wave of patients. Our country is rated 36th out of 191 nations in the quality of health care systems. Furthermore, it has three medical centers that have received the Joint Commission International Accreditation. There are only a total of four who have received this accreditation in Central America.

The PROMED Guide includes essential information on Costa Rica both as a destination for general tourism, as well as a destination for medical tourism. It also includes a complete directory of all the hospitals, ambulatory care clinics (including dental and orthodontic, plastic surgery, ophthalmology, bariatric surgery, and other specialties who offer quality care) that have been accredited internationally and are backed by PROMED.

Costa Rica’s location is strategic; there is political and financial stability and good quality of life. Medical technology is on the cutting edge, prices for medical care are affordable, and medical professionals are well qualified. All this makes our small country one of the best countries to visit for medical tourism. in the entire world.

At the same time, the Guide includes information on all those other services that are related to the international patient’s stay such as transportation, hotels, recovery centers, Physical Therapy services, Spas, and others.

Costa Rica has some of the best health conditions and indices at the level of many developed countries despite not having the same level of financial resources. This is due to the fact that the government has given health services top priority

We hope that you are able to take full advantage of this valuable tool and that you remember that “IN COSTA RICA - EVERYTHING CAN BE CURED!” 2


Product Structure CONGRESS GUIDE (pag. 5 -18) PROMED INFORMATION (pag.19 -31) TOURIST SECTION (pag.32 -50) WORKBOOK (pag. 61 -75)

Alphabetical Section Commercial Section (pag. 81)

Profiles (pag. 106)

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Welcome to your Best Destination: Costa Rica The Concept of Sustainability

look like?

The development of sustainable tourism must be seen as a balanced interaction in our appropriate use of natural and cultural resources, the improvement of the quality of life of the local communities, and the financial success of the activity so that it can contribute towards national development as well. Sustainable tourism is not just a response to a need, but rather an indispensable condition for competing successfully now and in the future. (Denition of Sustainable Tourism CST 1997).

• This is the type of tourism that the country needs. • Whith operative efficiency, it promotes efficient utilization of resources resulting in savings. • A tourism that is committed to the community and its needs, while forging a solution and an obligation to protect the environment. • It is a certification that every tourist related business should obtain in order to conserve natural resources and manage natural risks.

Sustainable tourism is not a result of supply and demand, but rather it must be a condition as a model for development, that hinges on the need to satisfy society’s current requirements without compromising the rights of future generations to meet their own. In other words, the development of the country cannot be based on the uncontrolled exploitation of resources (natural, cultural, social, etc) in order to meet the current needs of the people (for food, housing, health, jobs, etc.) because these resources are the only recourse that future generations will have to be able to satisfy their needs.

The CST promotes actions that benet and help the entire country. ¡Get certied! DEPARTMENT FOR SUSTAINABILITY PROGRAMS COSTA RICA TOURISM BOARD (ICT) East side of the Juan Pablo II Bridge, La Uruca, San José Tel.: (506) 2299 5876 Fax: (506) 2220-35-59 P.O. Box: 777-1000 San José, Costa Rica www.turismo-sostenible.co.cr Source: Costa Rican Tourism Board

Certication of Sustainable Tourism (CST) The main objective of CST is to turn sustainability into something tangible, practical and necessary within the context of making Costa Rica’s tourism competitive, while improving how it utilizes its natural and social resources, incentivizing active participation on the part of local communities, and providing a new support for business competitiveness. • What does 100% responsible tourism

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ORGANIZERS

CO ORGANIZERS

SPONSORS

PLATINIUM

GOLD

BRONZE

STANDARD

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Sunday May 1 st

San José

02,00-06,00 08,00-09,00

Arrivals of buyers and international suppliers Get together, Ramada Herradura Hotel

Monday May 2nd

San José

8,30-9,00 Introduction and welcome Certificate Delivery PROMED´s Quality Seal. 09,00 Openning Stands Area Ribbon cutting 09,00-10,00 Panel The answer of self-insured employers to the challenges of USA Healthcare Reform. By Robert Repke, SIIA, Global Medical Conexion Moderator: Luis Diego Osborne PROMED

Cima San José Hospital

10,00-10,30 10,30-1,00

Coffee Break (Visit stands) Keynote Address

10,30-11,30 Health and Globalization: Business opportunities in Costa Rica. Coalición Costarricense de Iniciativas de Desarrollo, CINDE La Católica Hospital and Hotel 11,30-11,45 Importance of Ethics in Medical Tourism Dra. Maria Amalia Matamoro, Ethics Committee, PROMED UNIBE Clinic 11,45-1,00 Panel Legal Forum about Medical Tourism: The risks associated with medical tourism Erick Gatgens Steve Weiner, Mintz Levin JORGE KAM RIOS Moderator: José Antonio Muñoz PROMED

Clínica Bíblica, Hospital

01,00-02,00 Lunch (Visit stands) 12,30-02,00 Meeting Promotion Entities Latin America Medical Tourism 02,00-03,45 Workshops: for buyers 1. Legal responsabilities on the implementation of medical travel programs Steve Weiner, Mintz Levin 7


Moderator: José Antonio Muñoz PROMED 2. Reducing risks through accreditation AAAASF, AAAHC, INTECO: AAAASF: Dr. Ronald Iverson AAAHC: Arnaldo Valedon INTECO: Miguel García Moderator: Antonio Acosta PROMED

for Suppliers 1. How to market my services to American patients Kiki Bright, Thailand Medical Travel and Tourism; Pramod Goel, Placid Way 2. How to sell to corporate buyers Laura Carabello, CPR Marketing 3. Social networks and the web as a tool to promote Medical Tourism Florencio Marchelli, Empleos de America.com; Patrick Goodness, The Goodness Company 04,00-06,00 Business Round tables (just exhibitor and buyers) 04,00-05,00 Conference: Item needed to ensure the internationalization of world class services Cardiovascular Foundation of Colombia 05,00- 06,00 C o n f e r e n c e : Protection and HIPAA sensitive data handling Dr. Kenneth Wells, Allken Resources 6,00-7,00 National Production Business Encounters 08,00-10,00 Welcome Cocktail: Hotel Ramada Plaza Herradura “Turismo de Salud” Awards

Tuesday, May 3

San José

08,00 -11,00 08,30-10,30

Visits to hospitals, clinics and rehabilitation centers (buyers only) Keynotes

08,30-9,30 New markets for medical tourism: Sport Medicine Dr. Jeff Dugas, International Sports Surgeons, LLC Orthopedic aesthetics Dr. Raúl Mora Rojas Moderator: Dr. Victor Perez PROMED

9,30-10,30 The role of facilitators: good practices and requirements Tim Morales, Costa Rican Medical Care Robert Repke, Global Medical Conexions Phill Midden, Companion Global Healthcare Dr. Joseph Barcie, Medical Value Travel Moderator: Dr. Alfredo López PROMED 10,30-10,45 Coffee Break 10,45-11,45 Program Success Stories International Patients Care Renee-Marie Stephano, Medical Tourism Association Proexport Colombia Exportar Argentina ATP Panamá Moderator: Antonio Acosta PROMED

Instituto Costarricense de Turismo

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12,00-12,45 The tourism sector’s role in medical tourism industry Success Stories CANATUR Mauricio CÊspedes Tropical Expeditions Luis Salas Moderator: Paulo Vargas PROMED Banco Nacional de Costa Rica 01,00-02,00 02,00-04,00 02,00 - 03,00 03,00 - 04,00

04,00 08,00 09,00

Networking lunch Business Round Table (only for buyers and exhibitors) How to ensure quality, the growth of its international Dr. Emilio Williams, Johns Hopkins Medicine International How to market the supply of medical tourism in Costa Rica to U.S. consumers from the perspective of American television Sheryl Thacker, Three Star Media Productions, Inc.

Departure of buyers to Guanacaste Check in Hilton Papagayo Hotel Dinner en Hilton Papagayo Hotel

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Stand

Expositor Name

A 2 PROMED A 6 Herz Rent a Car A 8 Latin Orthopaedics Institute A 10 Dentilase A 11 Health Travel Network /Banco Nacional de Costa Rica A 12 Latam Health Solutions A 13 Hospital Hotel La Católica A 14 Hospital CIMA San José A 15 Prisma Dental A 16 Dentavac Dental Clinic A 17 Clínica Novadental Dental Clinic A 18 Clínica Vizualiza A 19 Kaver Dental A 20 Clínica del Vértigo ( Dr .Guth) A 21 Proexport A 22 Proexport A 23 Proexport A 24 Costa Rica Image Dental A 25 Health Choices International A 27 Lindora Cosmetic Center A 28 Destinos TV A 29 New Smile Dental Group A 30 Clínica Integral Dr. Christian Rivera A 31 Hospital Metropolitano A 32 Dental Cosmetics Costa Rica A 33 Scarless Surgery/ Bariatrics and Minimally Invasive Surgery A 34 Clínica Unibe A 35 Grupo Do It A 36 Hospital Clínica Bíblica

Stand

Expositor Name

A

Continental

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B 1 AAAHC B 2 Medical Tourism Association B 3 AAAASFI B 8 Puerto Vallarta B 9 ATP Panamá B 10 ATP Panamá B 11 ATP Panamá B 12 Argentina Healthcare- Fundación Export. AR B 13 El Salvador B 14 El Salvador B 15 Guatemala (Inguat) C 1 Hotel Alta- Hotel Parador C 2 Barcelo San José Palacios C 3 Hilton Hotels C 4 Montaña de Fuego C 6 Days Hotel C 8 Blue Rivers C 9 Holiday Inn San José- Escazú C 10 Muppys The Virtual Guide C 18 Hotel Ramada Plaza Herradura C 19 Grupo Martha Hotels D 1 Tropical Expeditios D 2 Meditek D 4 Inteligensa Centroamérica D 5 ICT D 6 ICT D 7 ICT

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11 D10

A13

A11

A15

A12

A14

A16

A10

A17

A9

A8

A36

A34

A32

A20

A33

A19

A35

A18

A21

A22

A23

A30

A6

A31

A28 A29

A2

A26

A5

A25

A38

A24

A37

A4

A3

A1

A27


• American Association for the Accreditation of Ambulatory Surgery Facilities • American Society of Plastic Surgeons • American Association for Plastic Surgery • American Society for Aesthetic Plastic Surgery • California Society of Plastic Surgeons

Speakers

Dr. Iverson specializes in Breast Surgery including Augmentation Mammoplasty, Round and Anatomic Shape Implants, Breast Lifts, Breast Reconstruction, Breast Reduction and Mastopexy. Body Sculpturing and Recontouring - Lipoplasty, Mommy Makeover, Abdominoplasty. UltraPulse CO2 Laser Resurfacing Facial Rejuvenation - Facelift, Eyelid and Nasal Surgery, Lip Augmentation and Chin Implants. Too, specializes in Ancillary Beauty Services - BioMedic Clinical Treatments, Chemical Peeling Treatments, Glycolic acid, Salicylic Acid and TCA Peels, Collagen Replacement Therapy, Botox Injections, Dysport, Sclerotherapy (spider vein injections), Sculptra, Juvaderm, Restylane, Latisse and Active and Deep FX (Fractional Laser Treatment).

STEVE WEINER Steve chairs Mintz Levin’s Health Law Section. He has had over 30 years of experience in the health care field as a policy maker, educator, and attorney. He has also participated in a number of international health care activities, including structuring the health care regulatory system for the Dubai Healthcare City. Steve also works extensively with the U.S. Department of Defense on Matters relating to the Tricare Prime benefit and the operations of the US Family Health Plan program. Steve is a graduate of Harvard College, magna cum laude, and of Yale Law School.

PHIL MIDDEN Phil Midden is Operations Manager at Companion Global Healthcare. Before Companion Global Healthcare, he spent time at BlueCross BlueShield of South Carolina, Weathernews, Inc., GE Power Systems and WestPoint Stevens. He arrived at BlueCross in 2003 and helped develop a managed vision product for large group accounts. He also spent significant time expanding the marketing of value-added discount programs as the Manager of Complementary Healthcare Programs. Mr. Midden earned a BS in Atmospheric Science from Creighton University and an MBA from Clemson University. He is a licensed life and health insurance producer in South Carolina and holds the Fellow, Academy for Healthcare Management designation (FAHM). Mr. Midden has also completed training with the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). He is active with the Spring Valley Rotary Club.

DR. ERICK GATGENS GÓMEZ Specialist in Criminal Sciences graduated with honors from the University of Costa Rica. He has completed doctoral studies in Criminal Law and Criminal Procedure at the Ludwig Maximilian University in Munich. He is author and coauthor of books and articles published in Costa Rica and abroad. Member of American Institute of Procedural Law. He has worked as a consultant of the IDB and USAID, on issues related to criminal and procedural reforms. And has served as a trial lawyer from 1993 until today as Deputy Judge of the Third Chamber. RONALD E. IVERSON, M.D., FACS Graduated like a Plastic Surgeon in Stanford University Medical Center. Is part of The American Board of Plastic Surgery, Inc. 1974. And the next Societies:

DR. JOSEPH S. BARCIE, MD, Ph.D President of CIMA Centralized Services .Dr. Barcie received a BA in Chemistry and a Ph.D. in Molecular Biochemistry. He also earned an MBA in Healthcare Administration from 12


the University of California, Irvine and received an MD degree (non-practicing) from the University Autonoma Cd.Juarez in Mexico. He is an Adjunct Professor at Dartmouth School of Medicine, a member of the American College of Healthcare Executives, the Healthcare Information and Management Systems Society and the Association of Clinical Research Professionals. Most recently Dr. Barcie has been in a variety of senior level positions with HCA related to clinical services. He has served as a hospital Chief Operating Officer (COO) and has been a Chief Information Officer (CIO), he established a post graduate medical residency program, involved in forming continuing medical education programs and the creation of a group purchasing consortium.

e-Business strategies for Proveedores de América. com, Empleos de América.com and Instituto de Educación Contínua IDECO. Is a systems engineer and holds a Master in Computer Security has been developed as a consultant in e-Business, and holds a Master in Computer Security. Broad has extensive experience in e-marketing and coordination of projects e-Business, international tenders, detection and mapping of opportunities and defining business strategies. LOU AGUILERA Is the President of PROEXA. Project Developer of Pacific Plaza: Integral Community development for retirees and the President of Association PRORETIRE.

KIKI BRIGHT Is a co-founder of Thailand Medical Travel & Tourism, Inc and the founder of medical tourism in the East of Thailand. Ms. Bright has extensive experience in tourism and medical tourism industries and had years of experience working as a Government-licensed English and French speaking tour director in Thailand. In 1999, she founded her own travel agency in Bangkok and specialized in arranging medical travel for foreign clients from every corner of the world. Her pioneership and innovation as one of the first inbound medical facilitators has contributed to today’s extant 2 million medical travelers and 20 billion dollars worth of business to Thailand per year.

ROGER PETERSEN Roger Petersen is a partner in the Costa Rican law firm of Petersen & Philps and founder of Attorney Property Services, a Costa Rican real estate transactions services firm. He has been practicing law for 16 years. Mr. Petersen is a member of the Costa Rican Bar Association and the Florida Bar. In addition to his legal education, Mr. Petersen holds a B.A. from Tulane University in International Relations and an M.B.A. in Finance from National University in Costa Rica. Mr. Petersen was born in Costa Rica and lives there full time. He is also the author of the best selling book, The Legal Guide to Costa Rica.

Ms Bright holds a BA degree in English from Thammasat University (Thailand), tourist guide license from Faculty of Archeology at Silapakorn University (Thailand), and Business Management/ Marketing Certificate from University of California, San Diego, U.S.A. She is also a volunteer lead trainer for Travel With Assistance Foundation , a 501( c) 3 Non-profit organization.

PATRICK GOODNESS With more than 20 years of advertising, marketing and public relations experience under his belt, Patrick Goodness is the energetic driving force behind The Goodness Company’s success. Goodness began his career with the illustrious Leo Burnett Company in Chicago, and cut his advertising and public relations teeth on such accounts as Oldsmobile, United Airlines, Nintendo, Tropicana and Philip Morris Companies. Since the inception of The Goodness Company

FLORENCIO MARCHINELLI Mr. Marchelli is president of the Association for Sustainable Digital Development in Latin America and the Caribbean (ADDSALC). Also president of the company Do It On Line with U.S.! SA, Costa Rica, where is responsible for managing a group of companies and coordinating 13


Relationship Management (CRM) initiative within Johns Hopkins Medicine, a program aimed at securing the loyalty of Hopkins’ customer base through a unique combination of operational improvements and traditional marketing.

in 1994, Goodness has used his experience to gain such major league clients as the US Federal Government, Microsoft, Allstate, Allegiance Healthcare, The Swiss Colony, Chase Manhattan Bank, TCF Bank, American Airlines, Restaurant.com, the American Lung Association and many others.

Williams is co-founded GD Solutions, a multimedia communications company specialized in developing healthcare information for the Spanish and Portuguese speaking communities. During his tenure as CEO, he was a consultant to the National Institutes of Health, (NIH), Johns Hopkins Medicine, Dupont Pharmaceuticals, Glaxo Welcome, among others.

Patrick’s successful track record with client relationships is the primary reason The Goodness Company has held tight to valued clientele while most agencies experience dramatic annual client turnover. His ability to drive remarkable levels of positive publicity and “buzz” from a limited budget is the primary reason The Goodness Company is the smallest agency in the US with multiple Fortune 50 Accounts!

The institution for which he works, the Standards Institute of Costa Rica (INTECO) is a private, nonprofit organization founded in 1987 and recognized in 1995 as the National Board Standards. Is also part of the Pan American Standards Commission (COPANT), continental body that brings together the National Standards Bodies and the International Organization for Standardization (ISO), among other important organizations.

JAMES PAVLETICH, MHA, CAE James Pavletich is Vice President and Chief Operating Officer of the Accreditation Association for Ambulatory Health Care (AAAHC). He has been with AAAHC since 2005. He has twentythree years of management experience in working for or with healthcare related not-forprofit associations. In his role at AAAHC, Mr. Pavletich is responsible for the organization’s Information Technology, Marketing and Finance areas. He also serves as the staff liaison to the AAAHC International Board of Directors. Mr. Pavletich has earned the Certified Association Executive (CAE) designation from the American Society of Association Executives. Prior to working at AAAHC, Mr. Pavletich served as a senior project manager at TMA Resources, Inc., a provider of Customer Relationship Management (CRM) software solutions for the association industry. He has also held management positions at the American Medical Association, the International College of Surgeons and the American College of Healthcare Executives.

EMILIO WILLIAMS In the last 10 years, Williams has led several high-profile, innovative projects within Johns Hopkins Medicine in Baltimore. As a Director at Johns Hopkins Medicine International, Williams was in charge of using traditional and new ways of communication to expand worldwide the mission of Hopkins. Conceived and launched the first formal Customer

ARNALDO VALEDON, MD Arnaldo Valedon, MD is an anesthesiologist practicing in the fields of outpatient surgery and perioperative management for fifteen years. He received his bachelors degree in science at Cornell University in 1987, and his doctorate degree in medicine at the University of Pennsylvania in 1991. He continued his training in

Patrick also brings several years of international consultation experience, offering consultation services to such notables as American Airlines and the governments of Argentina and Costa Rica. MIGUEL A. GARCIA ROLDAN, INTECO Is a Bachelor of Industrial Engineering. Worked like an Inspector in monitoring the project ENERGIZE and is currently a Product Certification Auditor of INTECO.

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anesthesiology and critical care medicine at the University of Pennsylvania, with sub-specialty training in pediatric anesthesia at the Children’s Hospital of Philadelphia. After finishing his training, Dr. Valedon has provided outpatient anesthesia services almost exclusively. He has served as medical director at two outpatient surgery centers, and President of Summit Anesthesia and Perioperative Management since 1998. This practice was merged into First Colonies Anesthesia Associates in 2004 where he serves as a managing partner and chief of the ambulatory surgery division. Dr. Valedon is also a board member of the Ambulatory Surgery Center Association, the Ambulatory Surgery Foundation, the Acreditation Association for Ambulatory Healthcare(AAAHC), and AAAHC International. He has been involved with the American Society of Anesthesiologists as part of the ambulatory surgery committee, as well as the Society of Ambulatory Anesthesia as chair of the Latin-American relations committee and co-chair of the committee on office-based anesthesia. He is an active surveyor with the Accreditation Association for Ambulatory Healthcare and the Center for Medicare/Medicaid services.

procedures would cost in US. These 2-minute segments will be filmed in Costa Rica and will cover such topics as the doctors, the hospitals, the procedures, dental work and the medical products used in the surgeries. It will also cover how to travel to CR, travel agencies, airlines and accommodations or where to stay after their medical procedures are performed. RENEE MARIE STEPHANO Renee-Marie Stephano is the President of the Medical Tourism Association™. Is also the Editor-in-Chief of the Medical Tourism Magazine and Health Tourism Magazine. Having a background in international marketing and relations, health law and litigation, she provides a valuable service to the Medical Tourism Association™ in these fields. Ms. Stephano speaks regularly at international healthcare conferences on the Legal Issues Surrounding Medical Tourism and in the United States to employer groups, insurance groups and physician associations. Renee-Marie consults international government ministries, private sector organizations and NGO’s about the growth of the global healthcare industry and accreditation, providing marketing assistance to promote their countries high quality of care. Ms. Stephano works with governments and healthcare clusters in the development of their Medical Tourism Initiatives. Ms. Stephano recently is the co-author of three books: “Developing an International Patient Center: A Guide to Creating the Best Patient Experience”, the book “The Medical Tourism Facilitator: A Best Practices Guide to Healthcare Facilitation for International Patients” and the book: “Medical Tourism ~ An International Healthcare Guide For Insurers, Employers and Governments”

SHERYL A. THACKER Sheryl has been in media sales and marketing for 30 years. She has sold television commercial time nationally in NY and locally for television and radio stations in Charlotte NC, Raleigh NC and

Atlanta Ga. In 2003, through her knowledge of marketing and advertising, Sheryl created the TV show “Consumer 411”. The weekly show launched in Atlanta in 2004 and highlights companies, products and services that are available to the viewers. In 2008, Sheryl moved to Dallas, Texas and launched Consumer 411 on the air in the Dallas-Fort Worth market. She is the host of Consumer 411 TV show and has also hosted a weekly radio show on CNN in the DFW market.

KENNETH D. WELLS, MD Kenneth D. Wells, M.D. has over 20 years of health care experience, spanning occupational medicine, medical management, public health, family medicine, health education and pharmacy. Dr. Wells founded Alken Health Resources as an administrative resource to provide medical direction and service to

In 2011, Sheryl and her company “Three Star Media” will produce Costa Rica 411. Costa Rica 411 are 2-minute Medical Travel segments that will be filmed in CR and aired nationally in the US. These segments will educate the US consumers about medical procedures they can have done in Costa Rica at a fraction of the price these same 15


Fortune size companies. Alken’s services allow corporate clients to focus on their core business, while reducing costs, and enhancing health services. His corporate experience includes program start-ups and reorganizations. He has developed and managed several national and international programs.

medicine assistance for the Birmingham Barons, the AA affiliate of the Chicago White Sox and the Alabama Ballet.

Dr. Wells has held advisory positions with The Robert Wood Johnson Foundation, The University of Texas Health Science Center in Houston, The University of Texas College of Natural Sciences Advisory Council, The Washington Business Group on Health, and The Agency for Health Care Policy and Research. He is a member of Leadership Houston, Center for Houston’s Future, and the American Leadership Forum.

2004.

TIM MORALES Timothy Morales, is Costa Rican Medical Care founder and President of HSA Clearing Corp also founded HSA Trustee Services, a nationwide provider of no-monthly-fee Health Savings accounts since the program’s inception January,

Mr. Morales, a former stock and commodity broker and entrepreneur, is the founder of HSA Trustee Services and HSA Clearing Corp. After reading the Medicare Modernization Act of 2003 which outlined the new Health Savings Accounts, Mr. Morales realized the growth potential of this new market would be similar to the establishment of IRAs in the 1970’s.

JEFF DUGAS Dr. Dugas has contributed significantly to the research of sports medicine. He has published articles and textbook chapters related to injuries of the shoulder and elbow in throwing athletes, vascular injuries in throwers and rotator cuff injuries. He has also published manuscripts on the treatment of knee ligament injuries and the treatment of cartilaginous defects of the knee.

Prior to forming HSA Trustee Services and HSA Clearing Corp, Mr. Morales was in the financial service business as a stock and commodities broker. He has held a Series 7, Series 63, and Series 3 licenses. He traded Euro Dollars, Canadian Dollars and Gold on the floor of the Chicago Mercantile Exchange. He is also a former elected alderman for the City of Lake Geneva, serving a two year term before his relocation outside the city limits.

A native of Schenectady, New York, Dr. Dugas graduated from North Carolina State University in 1990 with a bachelor’s degree in chemical engineering. He continued his education at Duke University School of Medicine, graduating in 1994. He completed his orthopedic surgery residency at the renowned Hospital for Special Surgery in New York City.

CAROLE VELOSO Carole Veloso is Chief Executive Officer at Health Choices International and Health Care Consultant at Independent Consulting. She has been Senior Vice President Clinical Services and Quality Management at One Global Med, Chief Executive Officer at Hospital CIMA San Jose at International Hospital Corporation, VP Acute & Ambulatory Services at Bergen Regional Medical Center, Chief Executive Officer at Northside General Hospital and Consultant at URBAN HEALTH PLAN, INC.

Dr. Dugas holds memberships in numerous medical societies including the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine American Medical Association, Medical Association of Alabama and the Jefferson County Medical Society. He also participates as a team physician for Troy University and Vestavia Hills High School, Hoover High School, Calera High School, Cordova High School and Bessemer Academy. Dr. Dugas also provides sports

She holds an unique experience in global healthcare delivery involved with the development of governmental strategies to 16


improve medical patient flow to foreign countries.

Integrated Benefits Institute, past Board member of the Western Protectors Insurance Company and is currently on the Board and Executive committee of the Self Insurance Institute of America.

BRAD COOK Brad Cook has over 15 years of experience coordinating medical services for international patients at Clinica Biblica Hospital where he heads the international department of the hospital.

CINDE “Coalición Costarricense de Iniciativas de Desarrollo” The Costa Rican Coalition for Development Initiatives (CINDE) is a private, non partisan and nonprofit organization. During his 25 years, CINDE has attracted more than 200 companies in Costa Rica, including global leaders such as Intel, Procter and Gamble, Hospira, Baxter, St Jude Medical, Western Union and many more. CINDE ranks among the top 10 Investment Promotion Agencies (APIs) worldwide, according to “Global Benchmark Report 2009 investment promotion, service conducted by the Investment Climate Assessment (FIAS) of the World Bank Group. CINDE actively participates in international forums related to monitoring and promoting foreign direct investment, such as the World Association of Investment Promotion Agencies (WAIPA).

The company of Mr. Cook “Medical Tours Costa Rica” directs the program for Medical Tourism and Hospital Clinica Bíblica is part of developing a second project called “Surgical Trip” which provides medical services and consulting to insurance companies and self insured U.S. through a network of hospitals around the world. This model has Clinica Biblica Hospital positioning as one of the most popular destinations for international patients and medical tourism agencies. Brad is a recognized expert in the field and implementation of a medical tourism program, having participated as a lecturer and taught workshops at conferences where he has exhibited on the subject of medical tourism.

CANATUR Costa Rica’s National Tourism C h a m b e r (CANATUR) was founded in 1974 as a nonprofit organization, with the main purpose of integrating the private tourism iniciative. CANATUR is the leading entity of Costa Rican business organizations that brings together the highest hierarchy of the chambers and associations of the country’s private tourism sector, whose members represent the national tourism industry. Thus, CANATUR represents the entire Costa Rican business sector, both consolidated and united, reason for which it is one of the organizations of the civil society with greatest prominence within the national arena.

Mr. Cook the “Strategic Development Officer for Latin America” and “Advisory Board Member” of the Medical Tourism Association and is a graduate of the University of Calvin College in Michigan. ROBERT J. REPKE Mr. Repke has worked in the field of reinsurance for over 25 years. He managed and led all Treaty, Facultative and Direct Reinsurance lines for Employers Reinsurance Corporation in the Western United States. In early 1991, he started and led the Healthcare division at the General Reinsurance Corporation. Upon the acquisition of Cologne Re, he co-founded and shared the leadership of the GenRe and CologneLifeRe International Council. In 2001 he founded IC West Insurance Services, which works with US carriers as well as Lloyd’s underwriters, specializing in employer stop loss, reinsurance and product development. Co-founder of Global Medical Conexions, Inc., an International Select Provider Organization. As President of GMCx, Bob works to bring international options to employers, employees and individuals seeking medical care outside the United States. He is past Chairman of the

TROPICAL EXPEDITIONS Tropical Expeditions is a pioneer in Costa Rica’s medical tourism industry, offering high class transportation and assistance to medical travellers. 17


FUNDACIÓN CARDIOVASCULAR DE COLOMBIA

CAMARA DE TURISMO DE GUANACASTE

Colombia Cardiovascular Foundation is a health institution created in 1986 in Bucaramanga, Colombia, working with criteria of excellence, technological innovation and high social sense, to give our users the best care and quality assurance in the provision of health services. The Heart Institute was the first institution with Accreditation in Health in Colombia, by the Ministry of Social Protection, and is ranked among the top five hospitals in the country, at a level of excellence. It was also the first company to obtain hospital in January 2001, the ISO 9001 certification for all its services and is certified as ‘Hospital Without Pain’ by the Colombian Association for the Relief of Pain.

Is a nonprofit association that works entirely by improving the conditions of Guanacaste, both for its residents, visitors and investors. Was founded in 1995, involved in founding several local business people including Mr. Hubert Gysemans. Start with about 25 members mainly in the canton of Santa Cruz as an initiative to organize the sector and defend their interests. One of the most important achievements in recent years was the active participation in the commission of preopening Daniel Oduber airport in Liberia, joint committee of public and private sector, chaired by Mr. Hubert Gysemans. Subsequently, the Chamber participates and leads in the alliance between Reserva Conchal, Hacienda Pinilla and Eco Papagayo to secure the funds required for Delta Airlines began flights to the airport. This was the beginning of growth as a tourist destination Guanacaste.

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Institutional summary

sector, PROMED drives the coordination between the private and public sectors to attain Costa Rica’s international consolidation, and it does so through its private role in the medical tourism cluster.

The Council for the International Promotion of Costa Rica Medicine PROMED is the private not-for-profit organization that coordinates the efforts carried out to ensure the quality of services provided by the private health industry in Costa Rica and their international promotion, with the intention of consolidating the country as a center for global medicine and a major destination for medical tourism.

In the same way, it leads the implementation of the actions necessary to strengthen the offer of health tourism services to reach greater international competitiveness.

Medical tourism X-ray

This board was born out of the need the private sector and the State had to supervise the quality of services rendered to medical tourism patients with the purpose of guaranteeing the sustainable growth of this industry.

Definition. Medical tourism is the practice of traveling to another country to receive professional medical attention at a cost lower than in the country of origin. This includes both elective procedures and specialized surgeries.

To fulfill this goal, PROMED develops regulatory standards and promotes the certification of service providers, with the support of international bodies and the training of local certifiers.

Main medical tourism destinations • Costa Rica • Mexico • Panama • Brazil • Hungary • India • Thailand • South Korea • Taiwan • Singapore • Malaysia • South Africa • United Arab Emirates

PROMED also looks to: • Secure Costa Rica’s position internationally as a medical tourism and retirement destination based on high-quality medical services and the hospitality image that already distinguishes the country. • Ease the opening of new international markets by comprehensively promoting health and medical tourism. • Support the efforts of health authorities to standardize medical attention services.

Relevant figures in medical tourism

• Participate actively in the development of national strategies for promoting and attracting investment that benefits both industries.

• In 2006, the medical tourism industry grossed about US$60 billion worldwide, with estimates of reaching US$100 billion by 2012. (McKinsey & Company)

• Educate and support the creation of a more highly professional and specialized human capital within the tourism and health industries to improve their competitiveness.

• It is projected that by 2015, the United States will spend over 20% of its annual GDP on medical services. • By 2015, the potential market in United States will include 220 million individuals over the age of 50. • Currently, nearly 11,000 individuals turn 50 daily.

PROMED brings together health service providers, health professionals, tourism service providers, academia, and other marketers of goods and services related to health and tourism.

• Presently, 47 million Americans do not have health insurance or are under-insured.

As a reference body in the medical tourism 20


Costa Rica’s health system

• 108 million Americans do not have dental insurance.

Costa Rica’s national health system is comprised of:

• In 2007, an estimated 750,000 Americans traveled to another country for medical attention.

• The Ministry of Health, which leads the sector. • The Costa Rican Social Security System (CCSS), which provides care in case of disease and maternity.

• It is estimated that in 2010 over 6 million Americans will travel abroad to get medical attention.

• The National Insurance Institute (INS), which offers protection against work-related and transportation related injuries.

About Costa Rica

• The Costa Rican Institute of Water and Sewage Systems (AyA), which regulates the water supply for human consumption and the management of sewage.

Costa Rica: quality health care and nature within your reach. • Costa Rica ranks 36th in health systems worldwide, according to ‘The World Health Report 2000 – Health Systems: Improving performance’.

The State Treasury assigns a budget to public institutions, and the CCSS is financed by contributions from employers, workers, and the State.

• The country holds the highest rank in political stability and absence of violence in Latin America according to ‘The World Bank’, 2007.

Costa Rica: health core indicators

• It has the best educational system in Latin America according to ‘The 36th worldwide World Economic Forum, Global Competitiveness Report 2007-2008’. • Adult literacy rate is 94.9% according to ‘The World Economic Forum, Global Competitiveness Report 2007-2008’. • San José ranks 4th among the cities with best quality-of-life in Latin America according to ‘The Economist Intelligence Unit, Habitability Rankings 2008’. • FDI Magazine named Costa Rica as the Central American Country of the future, 2007-2008. • The country is the first high-tech exporter of Latin America according to ‘The 5th worldwide World Economic Forum, Global Information Technology Report 2007-2008’. • Costa Rica is first among Latin American countries in ‘The Worldwide Business Trip Index, The Economist Intelligence Unit 2006’.

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Why Costa Rica

Health Indicators: comparison

Strategic Location • Costa Rica is located in Central America. • The country’s time zone corresponds with the US Central Standard Time Zone (GMT-6). • There are over 20 direct flights arriving to Costa Rica from many different US and Canadian cities. • The weather is pleasant and mild all year long, with two established seasons, the dry season, which goes from December to April, and the rainy season, which goes from May to November. • Costa Rica is a tropical country with an average temperature of 22°C (72°F). The temperature is slightly higher in the coastal areas.

Economical and political stability Thanks to the excellent academic level of the general population, its high-quality modern services, and its social and political stability, Costa Rica attracts substantial foreign investment and offers great potential for the establishment of renowned multinational companies. Costa Rica is proud of its centenary history of democratic tradition and its over half-century without an army, which was abolished in 1948. This has promoted a culture of social peace that makes the country a very nice place to visit.

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State-Of-The-Art medical technology

The country’s savings by not having a military are invested in improving living standards

• Costa Rica offers domestic and foreign patients the latest medical technology available on the market because of the synergy that exists between the country’s healthcare and growing medical devices industries. • Costa Rica’s medical devices industry began to truly develop in 1987, when Baxter Healthcare established a manufacturing operation in the country. • Today, there are 25 medical devices companies in Costa Rica including world leaders Hospira, Boston Scientific, Cytyc-Hologic, Arthrocare, Allergan, and Coloplast.

Quality of life

• Costa Rica’s main strength is its human and intellectual capital.

According to the Economist Intelligence Unit (2008), San José ranks 4th among Latin American cities in Best Quality-of-Life.

• The medical devices industry employs 6,300 people. • The medical devices industry is the 4th largest exporting industry in Costa Rica; with exports having grown 3 times faster than the rest of free trade zone exports. In 2007, exports reached the US$766 million and attracted US$150 million in FDI.

JCI accredited hospitals In Costa Rica, there are three JCI accredited hospitals, which also happen to be the only accredited health institutions in Central America:

Qualified medical professionals

• CIMA Hospital • Clínica Bíblica Hospital • La Católica Hospital

• Costa Rica relies on highly-qualified medical professionals: 44% of Costa Rican physicians hold a medical specialty. Almost 80% of Costa Rican physicians completed their studies either in the US or in Europe

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Opportunities and Advantages

• The country’s medical professionals have high-quality knowledge in healthcare, and they maintain continuous education, research, and service projects with worldwide institutions.

Advantages of Costa Rica • Strategic location in relation to its main markets.

• Costa Rican doctors offer personalized attention tailored to each patient’s specific medical needs.

• Political and economical stability.

• All staff, including doctors, coordinators and nurses, is bilingual; they speak and write English fluently.

• High quality-of-life standards. • Hospitals that are internationally accredited by the Joint Commission International (www. jointcommissioninternational.org). • Use of state-of-the-art technology. • Health professionals who are internationally recognized for their skills. • Internationally renowned tourist destination. Opportunities for Costa Rica • The medical tourist spends on average 5 times more than the vacationing visitor.

Top sustainable tourism destination

• In 2008, an estimated 25,000 medical tourists traveled to Costa Rica.

• In Costa Rica, patients recover while enjoying beautiful tropical beaches, big natural adventures, the wonders of nature, and a stimulating culture.

• The United States and Canada are the main source of Costa Rica’s medical tourists. • The average stay of medical tourists who come to Costa Rica is 11 days.

• The country encompasses 51,100 km2, which represents just 0.03% of the globe’s surface. Nevertheless, it proudly shelters 6% of the world’s biodiversity.

• The most common medical services provided to medical tourists are:

• 25% of the country is held as conservation and protected territory.

o Dental work – 36% o Surgeries – 22% o Medical treatments – 14% o Aesthetic surgeries – 12%

• Costa Rica’s northwestern area (Nicoya) is one of the world’s four “Blue Zones”, places where people live the longest and healthiest life spans. (Dan Buettner, National Geographic writer)

Benefits of Medical Tourism for Costa Rica • Higher direct foreign investment and services’ exportation. • More and higher quality opportunities for Costa Rican health professionals. • Higher earnings for the health and tourism industries and for their associated value chains. 24


• Continuous improvement of healthcare standards.

Board or Association: Council for the International Promotion of Costa Rica Medicine - PROMED.

• Internationally competitive prices.

Collective Mark: Collective Mark PROMED.

• Development and growth of social health projects.

Regulations: Regulations for the Use of the Collective Mark: “Collective Mark PROMED”.

Certification

Users: Individuals or legal entities that offer services related to medical tourism who may choose to use the Collective Mark, in conformity with the requirements in these Regulations.

Regulations governing the use of collective mark of the board for the international promotion of medicine in Costa Rica - PROMED “COLLECTIVE MARK PROMED”

Services: Health services, physical and mental wellness, tourism services, academia, goods and services providers, all of them related to the health, medicine, wellness, and tourism industries; medical and pharmaceutical research centers, and training centers with careers related to health, medicine, and wellness. Regulation and Evaluation Committee: Supervisory means for the use of the Collective Mark.

I. OBJECT OF THE REGULATIONS These Regulations aim at governing the granting and use of the collective mark called “COLLECTIVE MARK PROMED” by establishing:

III. HOLDER OF THE COLLECTIVE MARK A. Holding firm: “Collective Mark PROMED” is exclusive property of the Council for the International Promotion of Costa Rica Medicine - PROMED.

a. The common characteristics and qualities that the services covered by the Collective Mark must meet. b. The specific conditions and particular characteristics of the services for the use of the Collective Mark.

B. Domicile and headquarters: The board is established in the headquarters of the company Homewatch Caregivers, located in Escazú, at the KPMG building.

c. The individuals and legal entities that may choose to use the Collective Mark.

C. Object of the Board: The Council for the International Promotion of Costa Rica Medicine ¾PROMED¾ is the non-profit private organization that coordinates the efforts carried out to ensure the quality of the services provided by the health industry in Costa Rica and their international promotion, with the intention of consolidating the country as a center for global medicine and major destination for medical tourism.

d. The dispositions to secure and control the use of the Collective Mark. e. The punishment in case of breach or violation of what is established in these Regulations. II. DEFINITIONS For the purposes of these Regulations governing the use of the Collective Mark, the following terms mean:

D. Management body: The Board is represented by the Chairman of the Board, possessing the judicial and extrajudicial representation and powers of General Agent; if absent, he will be 25


substituted by the vice-president of the Board, with the same powers and obligations of the President.

an entity avowed by the Government of the United States, Canada, or European countries: for example, JCI, AAAASF, and AAAHC.

IV. COLLECTIVE MARK

C. Specialist clinics and doctor offices will also have to have a support agreement for the care of complications.

A. Nature: “Collective Mark PROMED”, in compliance with the Law of Brands and Distinctive Symbols, is a collective mark created to be used by individuals and/or legal entities that comply with the requirements established for that purpose in these Regulations.

D. Health care professionals who work for this company will have to be duly accredited and affiliated to the respective professional school. For businesses related to health, and physical and mental wellbeing:

B. Collective Mark: “Collective Mark PROMED”. C. Services: The Seal will apply to the member services of which fulfill the requirements in accordance with the norms hereby stated in these Regulations.

A. To meet the standards and requirements established by the Government of the United States, Canada, or European countries. B. Health care professionals who work for this company will have to be duly accredited and affiliated to the relevant professional school.

D. Individuals authorized to use the Collective Mark: The Collective Mark can be used by: a. The Board itself as holder.

C. To have INTECO’s or a related “Health Tourism” certification.

b. The active members of the Board, as long as they comply with the requirements established in these Regulations.

For health professionals: A. To have the duly accredited medical or dental specialty.

c. Individuals or legal entities that comply with the requirements established in these Regulations.

B. To be included in a professional recertification system of the relevant professional school.

V. CONDITIONS FOR THE USE OF THE COLLECTIVE MARK

C. To operate on their own, nationally and internationally credited structure, or to have credentialing from a nationally or internationally accredited hospital.

Individuals or legal entities that wish to be creditors of the collective mark must comply with the following requisites, in the following order, and in conformity with the sector they represent, as well as without exception, must pay an amount equivalent to five hundred American dollars ($500 USD) to acquire the right of use for three (3) years:

D. To be duly credited and affiliated to the relevant professional school. 2. Tourism services providers (individually or in association): A. To have ICT’s tourism declaration.

1. Health services providers:

B. To have an emergency service available for the transfer of patients.

For public and private general hospitals; specialist clinics; and doctor offices:

C. To be located no more than thirty (30) minutes away from a medical facility that is appropriate for treating possible complications.

A. To have national accreditation and qualification from the Ministry of Health. B. To have one international accreditation from

D. To have INTECO’s or a related “Health Tourism” certification. 26


resolution issued by the Board of Directors.

3. Academia (individually or in association):

c. Once the requirements are verified and in order, the Board of Directors grants the right of use of the Collective Mark in conformity with the guidelines established in these Regulations.

A. To have an international accreditation avowed by the Government of the United States, Canada, or European countries, such as the Certificate of Compliance with the Standards of Comparability with United States’ medical schools.

VII. USE OF THE COLLECTIVE MARK

B. To have among their careers the health, medicine, wellbeing, and tourism-oriented ones; medical and pharmaceutical research centers; and a training center with careers related to health, medicine, and wellbeing.

A. PINDIVIDUALS WHO CAN USE THE COLLECTIVE MARK: The Collective Mark can only be used by individuals or legal entities that shape one of the categories of the associated groups or interested third parties specified in the sixth item of the Board’s bylaws. These groups are:

4. Suppliers of goods and services: A. To have the law permits relevant to their operations.

a. FOUNDERS: these are the participating affiliates in the Constituent Assembly.

B. That their products or services are registered correctly and have the approval of the competent authority.

b. ACTIVES: besides the founders, will be affiliates who later joined the Constituent Assembly or the first Ordinary General Assembly, and who are in full possession of their rights.

C. That their products or services have official approval or international certification.

c. HONORARIES: ACOPROT, CINDE, “Comercio de Costa Rica”.

VII. BOARD OF DIRECTORS The Board of Directors will be the Board’s body responsible for ensuring the faithful observance of all the requirements established in this contract to opt for the use of the Collective Mark.

d. THIRD PARTIES: interested parties that are part of any of the associated groups of the Board and that comply with the requirements established in these regulations for the use of the collective mark.

The Board of Directors will have the following powers:

Founding and/or active members are comprised of the following sectors:

a. Once the Affiliate and/or interested third party presents all the documents to opt for the Collective Mark, the Board of Directors will perform a documented analysis through which it will verify that every requisite established in the documentation mentioned in the previous item, is observed.

• Health services providers: public and private hospitals, specialized clinics and doctor offices, businesses related to health and mental wellbeing. • Health professionals: these can opt for the Collective Mark in association through medical associations or private consortia formed by at least ten professionals: doctors and dentists, health professionals, alternative medicine providers.

b. Once every requisite is verified, the Board of Directors will evaluate and decide if the Collective Mark is granted. If the affiliate or requesting interested third party is dissatisfied in any way, they have ten (10) working days to appeal the denial, for which the Board of Directors will have to analyze again the requisites presented by the Affiliate and will have fifteen (15) working days to decide on the appeal. There can be no appeal against the

• Tourism services providers: board and lodging companies, travel agencies, tour operators specializing in medical tourism, transportation companies (air, sea, land). 27


• Academia: public and private universities with careers related to health, medicine, wellbeing, and tourism, medical and pharmaceutical research centers, and training centers with careers related to health, medicine, and wellbeing.

distinctive capability is not altered or impaired, or it doesn’t breach the legal guidelines established in the Law of Brands and Distinctive Symbols. It can be adhered, printed, engraved, stamped, inserted, or in any way used in packing, bottling, boxes, receptacles, stationery, magnetic media, electronic media, and/or over any surface, murals, posters, or any other known or to be known media. It can be used indistinctly in the affiliates’ grounds or, in the case of third parties authorized to use the Collective Mark, these can only use it for the services provided by them. It can be used separately or in conjunction with another brand or distinctive symbol that is property of the authorized industrial or marketer. It will be used only to protect the services comprised by the Collective Mark.

• Suppliers of goods and services: pharmaceutical companies. Suppliers of medical equipment, consulting firms in the health and tourism sectors, healthcare industry materials providers, dental laboratories, pharmacies, clinical laboratories, medical tourism infrastructure developers. • Honorary affiliates: they will be, the Board itself, ACOPROT, CINDE, the Chamber of Commerce of Costa Rica, and everyone else appointed by the Board of Directors. B.

D. USE OF THE COLLECTIVE MARK IN ADVERTISING

PERIOD OF USE:

Once the Collective Mark is granted, there are three procedures to follow:

The users of the Collective Mark can use it in any media and advertising, following the standards contained in these Regulations.

1. Granting of the Collective Mark: from the time the affiliate or interested third party is notified by the Board of Directors of the approval of the granting of the Collective Mark, they will have the right to use it for a period of three (3) years.

E. SURVEILLANCE OF THE USE OF THE COLLECTIVE MARK The Regulation and Evaluation Committee, created for such purposes, will do the surveillance in conformity with the Association’s bylaws. It will be responsible for ensuring the faithful compliance with the conditions necessary to enjoy and use the collective mark in agreement with the established terms. For the effective control and surveillance, the Regulation and Evaluation Committee can carry out, if considered necessary, inspections to authorized affiliates, with the intention of ensuring compliance with these Regulations and the good use of the Collective Mark, in agreement with the established parameters. The Regulation and Evaluation Committee shall perform all necessary actions to avoid or prevent the misuse of the Collective Mark.

2. Maintenance: During the period of use of the Collective Mark, the Board of Directors can do inspections, in accordance with what’s established in these regulations, with the intention of verifying the faithful compliance and good use of the Collective Mark. If anomalies are found in regards to its use, one of the penalties for non-use mentioned in these regulations can be applied. 3.Renovation: Once the term is due, the affiliate who wants to continue using the Collective Mark will have to present and observe the requirements established in these regulations. For this, it will have to follow the Collective Mark granting procedure established in these regulations. C.

VIII. IMPROPER USE OF THE COLLECTIVE MARK

FORM OF USE

Not withstanding any provision in the Law of Brands and Other Distinctive Symbols, its regulation and other related legislation, improper use means any of the following acts:

The Collective Mark has to be used as it is registered. Variations in its size and colors will have to be authorized in advance and in writing by the Board of Directors as long as its 28


a. To use the Collective Mark without having the approval of the Board’s Board of Directors.

right to use it. d. WITHDRAWAL OF THE COLLECTIVE MARK: The Association’s Board of Directors can withdraw the user’s right to use the Collective Mark if they receive complaints by third parties or by members of the association in regards to the bad service, quality or safety of the services provided by the user.

b. To use the Collective Mark on services that do not comply with the characteristics established in these Regulations. c. When any of the affiliates grants license or permit to a third party for using the Collective Mark.

X. REFORMS, EXTENSIONS AND ALTERATIONS TO THE REGULATIONS

d. When any of the affiliates transfers its right of use without previous written authorization from the Board of Directors.

Any reform, extension, and/or alteration to these Regulations will have to be agreed by the Board’s Board of Directors, be it during a regular or special meeting. The Board of Directors will have to notify the Intellectual Property Registry of Costa Rica, in writing, about the changes or alterations in the Regulations.

e. To use the Collective Mark while altering or impairing its distinctive capacity; this will be determined by the Association. f. Any act that may impact the rights or interests of the Board over the Collective Mark.

XI. DISCLAIMER

g. To use the Collective Mark after the granting term is due.

The decisions made by the Board of Directors in regards to the Collective Mark through the application of these regulations are objective decisions based on the faithful compliance of the established requirements, requisites that will have to be observed by the users or applicants for the use of the Collective Mark.

IX. PENALTIES FOR THE IMPROPER USE OF THE COLLECTIVE MARK The Board of Directors will punish the individual or legal entity that is authorized to use the Collective Mark and that in any way uses it improperly, in accordance to the seriousness, importance, relapse, and circumstance of each case.

The Collective Mark object of these regulations guarantees that the users who hold it comply with high quality service and safety standards for the patient; however, the Association and/or Board of Directors are not responsible for the noncompliance with this quality. In this situation, and in agreement with what is established in these regulations of use of the collective mark PROMED, the Board of Directors can withdraw the use of the Collective Mark from the non-compliant user, and can ban its use during a certain period of time or permanently.

The Board of Directors can impose the following punishments: a. TEMPORARY SUSPENSION: It will be a temporary suspension of one year of the use of the Collective Mark. The Board of Directors will determine the term of the suspension in accordance with the seriousness of the improper use.

“Resolución Alterna de Conflictos” (RAC) - Alternative Disputes Resolution

b. PERMANENT BAN OF USE OF THE COLLECTIVE MARK: The Board of Directors can make this punishment effective when the user backslides.

RAC aims to resolve hereditary controversies, of available nature, about affairs related to the professional practice of health.

c. AUTOMATIC AND PERMANENT BAN OF USE OF THE COLLECTIVE MARK: Any affiliate who has been punished with a temporary suspension of the use of the Collective Mark and who doesn’t comply with this punishment, will immediately and permanently lose the

What is the RAC center?

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The Center for Alternative Disputes Resolution (RAC, by its initials in Spanish) of the College of Physicians and Surgeons of Costa Rica is an initiative born from the college’s governing board. It is the board’s body that aims to solve hereditary controversies, of available nature, about affairs related to the professional practice of health, through the administration of conciliation and/or arbitration mechanisms directed towards companies, professionals who are, or are not, members of the college, and health services users.

Conciliation processes These are the mechanisms through which two or more parties to a dispute look for mutually satisfactory solutions to their interests through the intervention of an impartial third party that facilitates communications during the process. Arbitration processes These are the mechanisms through which the parties subject the resolution of the dispute to an impartial third party called ‘ruling tribunal’ (individual or collegiate) for it to study the case and decide with a binding nature.

The Center is completely autonomous from the College, its governing board and other bodies, in regards to the management of the cases it handles.

It can be law arbitration (solved according to the current legislation) or equity arbitration (solved according to equity, prudence, and conscience).

The procedures related to affairs handled by the Center are completely confidential, independent and impartial.

Benefits of RAC processes

The “Dirección Nacional de Resolución Alterna de Conflictos (DINARAC) —National Management of Alternative Dispute Resolution— of the Ministry of Justice authorized the RAC, through resolution number 009-2008 DINARAC established at 13:00 hours of June 9th, 2008, to institutionally manage conciliation and arbitration mechanisms.

• The process is less expensive and less emotional for the parties involved. • The proceedings are confidential. • The proceedings are more agile and expeditious.

Types of cases handled

• The solutions reached have sentence character (mediation agreements or decisions).

The Center for RAC handles affairs that arise from the exercise of health sciences, be it between health professionals and patients, employers, clients, health institutions, administrative staff, or colleagues, as long as these are hereditary controversies, of available nature, that are lawful and possible. The College’s Moral Court will handle conflicts that encompass ethical responsibilities without hereditary impact.

• The solutions are more sustainable because these are built by the parties to the dispute. • The process creates a more favorable atmosphere to improve the relationship between the parties. • The process favors dialogue and social peace.

What services does it offer? Consultation services

How to make contact with the Center

The RAC offers information about the options available for someone who is in a dispute resulting from the hiring of professional health services.

In order to initiate the CONCILIATION process, all the parties involved in the dispute must voluntarily and freely agree to participate. Next, the interested party presents its case to the RACCMC Center for technical evaluation.

Reference services

If the dispute is deemed admissible by the RACCMC Center, a conciliator, selected from a list maintained by the Center, is assigned to the case. To initiate the ARBITRATION process, the contracting parties have to subscribe a ruling

When the conflict does not fall under the center’s scope, it can refer the person or institution to the relevant authority or agency. 30


clause in which by mutual agreement they decide to contact the RAC-CMC Center in case of conflict. When controversy arises, the interested party will request that the RAC-CMC Center initiate the process according to the current legislation.

either of the parties. Contact Fax: (506) 2210-22-69 and (506) 2210-22-68 Web: www.medicos.cr/centrorac Email: centrorac@medicos.cr Physical address:College of Physicians and Surgeons of Costa Rica, south side of “La Sabana” park, from the Ministry of Agriculture and Livestock (MAG, by its initials in Spanish), 75 meters east. Public opening hours:Monday through Friday from 8am until 5pm.

The RAC-CMC Center and PROMED The Council for International Promotion of Costa Rica Medicine -PROMED- endorsed the RAC Center of the College of Physicians and Surgeons of Costa Rica to resolve eventual conflicts related to health matters that a foreign patient may have when using the services of PROMED’s affiliates. This was done in consideration of the fact that for Costa Rica to be competitive internationally in offering health services, it is crucial to provide a method for the legal resolution of cases where a patient feels unsatisfied with the service tendered.

thank you very much

Visit:

Depending on the complexity of the case, resolution in the courts could take years to reach, with no guarantee of a satisfactory result for

www.promedcostarica.com

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32


COSTA RICA REVIEW

- Panama, West – Pacific Ocean and East – Caribbean Sea.

Located in Central America, Costa Rica has a surface area of 51.100 km2 and is a great destiny for the visitor. It is one of the countries with the largest protected areas of the world. Twenty five percent of the country is dedicated to national parks, land and marine biological resources as well as other wildlife protected areas. It has approximately 850 species of birds, of which 600 are residents and the rest are migratory that come from North America during the winter months and they usually stop here on their way to South America.

• Land length : 51.100 km2 • Maximum length: 464 Km. from the Sapoá River to Burica Point • Minimum length: 119 Km. from Tuba to Boca del Colorado • Maximum width: 259 Km. from Cape Santa Elena to Boca del Río Colorado River Mouth of the Colorado River). • Highest Mountain: Mount Chirripó (3.820 m above sea level)

According to its geographical coordinates, it is found between 8° 02’ 26” and 11° 13’ 12” to the north of the Equator and at 82° 33’ 48”west of Greenwich. From a geological perspective, Costa Rica is a young territory and the most recently formed in the neo-tropical region. Up until the beginning of the Tertiary Period, Costa Rica and Panama were covered by a great marine canal that connected the Caribbean Sea with the Pacific Ocean. It looked more like a type of archipelago than a solid continental mass. It has been established that the current Nicoya and Osa Peninsulas are remains of these first islands. From the middle of the Tertiary Period, strong tectonic and volcanic movements permitted the raising of land throughout the country and the appearance of a land fracture known as the Nicaraguan Depression from union mountain ranges found in Guanacaste and the central volcanic mountain ranges were found. However, it was during the Quaternary Period that the Costa Rican land mass was consolidated and it became the area where the first aboriginals were able to establish. This small country is big on activities the visitors can find sun, sea, adventure, nature into culture, in one place.

• Widest Crater: Poás Volcano (one of the largest craters in the world; it is 1 km in diameter) • National Flower: Guaria Morada (Guarianthe skinneri also known as Cattleya skinneri)

•National Tree: Guanacaste (Enterolobium cyclocarpurri) • National Bird: Yigüirro or Clay colored thrush or robin (tardus grayil)

General Information

• Weather: tropical with two seasons: dry (December to April) and rainy (the rest of the year)

• Capital: San José • Currency: Colón

• Population: 4.159.758 inhabitants

• Official language: Spanish, however a very good percent of the population speaks English.

• Subdivisions: 7 Provinces, 81 Cantons, 463 Districts.

• Time Zone: EST-1;GMT-6

• Electricity: 110 volts

• Country Code: (506) • Borders: North - Nicaragua, Southeast

• Quality of the water: 98% drinkable 33


• September 15: Independence Day

• Telephony: Costa Rica has a great telephone system that belongs to the government. In the all territory you can find a public phone.

• December 25: Christmas • Holy Thursday and Holy Friday: Holy Week

• Postal System: Central Post Office of Costa Rica.

Geographical Location

• Roads: The country has paved roads that allow travel around the country, and also travel truth Central America. Costa Rica has secondary roads as well.

Costa Rica enjoys a special position in the world map because it lies in the middle of the Central American Isthmus. It is bordered on the east and northeast by the Caribbean Sea, on the west and south by on southeast; and southwest with Panama and in the north by Nicaragua.

• Public transportation: Costa Rica’s taxis are red, airport taxi’s are orange. The service of buses is really safe and travels around the country.

Climate Costa Rica is a tropical country located between two oceans with a complex geography that gives origin to a variety of climatic conditions and creates a variety of life zones that go from the dry tropical forest to the moorland. In general, temperatures fluctuate between 14 and 22 degrees Centigrade. Even though there are clearly defined seasons, the climate in each region is fairly stable the whole year long with slight changes depending on whether it is “Summer” (dry season) or “Winter” (rainy season). The “Summer” generally runs from December to April and the “Winter” goes from May through November.

• Banking: You can use all the bank services, public or private. The schedule is between 08:30 am to 05:00 pm. Official Holidays • January 1: New Year’s Day • April 11: Juan Santamaría Day (national war hero)

Political System Costa Rica is a Democratic Republic with a President and a Constitution that is characterized by a system of weights and balances. The President holds the Executive Power and for this reason is the center of all the political power. There are two Vice-Presidents and a 15 member Cabinet. The President, along with the 57 Deputies of the Legislative Assembly, are elected for a period of four years. Through a change made in 1969, Deputies can be re-elected to Parliament for several non-consecutive terms. The same was done for the Presidential Seat in 2003. The Judicial Power of the Republic must ensure compliance of the Constitution and acts as a moderator in conflicts between the Legislative and Executive powers.

• May 1: International Workers’ Day • July 25: Annexation of Guanacaste

Costa Rica is subdivided into 7 Provinces which are then subdivided administratively into 81 ‘cantones’ or counties which have their own local

• August 15: Mother’s Day 34


governments headed by a Mayor. The Mayor is elected for a period of 4 years by direct vote of the people who live in that canton. The central government has an institutional autonomous system society that offers basic services to the people.

These are further subdivided into 463 Districts.

Some of these institutions include the Costa Rican Institute for Electricity, the National Insurance Institute and the Social Security System of Costa Rica known as the “Caja Constarricense del Seguro Social”. Costa Rica does not have an army and its internal security is guaranteed by the Police Force.

Provincia

Canton

1

Alajuela

15

108

9.757,53

2

Cartago

8

48

3.124,67

3

Guanacaste

11

59

10.140,71

4

Heredia

10

46

2.656,98

5

Limón

6

27

9.188,52

6

Puntarenas

11

57

11.265,69

7

San José

20

118

4.965,90

Districts

Area (Km )

The Capital Town

The country contributes to the development of democratic structures and the respect for the human rights. In Latin America, Costa Rica is well known because of its human rights and guarantees that offer Costa Ricans great opportunities in the Development.

San José is the capital of the Republic of Costa Rica. It is the government seat for the Province of San José. This city is the political and financial center of the country and is where more than half of businesses and services for the country are found. It was named in honor of Joseph of Nazareth, adoptive father of Jesus of Nazareth. Same as the founding cantons of the country, the central canton of San José was founded on December 7th, 1848. The population grew between 1737 and 1738, and it became the capital of the country in 1823. This is a city with an interesting mixture of history and modern times. Even though the most central part of town is almost uninhabited, it has become a place where over one million people pass through during the day generating traffic gridlock and increasing pollution levels.

Health and Education According to the World Health Organization, Costa Rica has one of the best health systems in the world. Child mortality has decreased while life expectancy has increased. Health System is in charge of managing diverse hospitals as well as covering services for the disabled, the elderly and maternity care.

Despite these problems, the studies that have covered all the cities of Latin America continue to place San José as one of the safest and least violent cities of the region. In 2006, it was acclaimed as the Cultural Capital of Latin America.

As far as education, the country has one of the highest literacy rates of the continent with almost 94% of the population being able to read and write. Provinces Costa Rica is divided into 7 provinces that are then subdivided into 81 cantones (or counties).

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Flora and Fauna

country. They are issue bills for a face value of 20,000 , 10,000, 5,000, 2,000, and 1,000 colones, as well as coins with a face value of 500, 100, 50, 25, 20, 10 and 5 colones each.

Costa Rica is an extraordinary refuge for life, full of natural surprises and while covering an area of 51.100 km, which represents only a 0.03 percent of the surface of the planet, it houses around 5 percent of the entire biodiversity of the world. The plant formations vary depending on altitude of the ground. In the tropical forest on the coastal areas of the northeast and south, rainfall is more abundant and the trees and vegetation take on large dimensions.

• Money Exchange: One can exchange currency in all banks (most open from 8:30AM to 3:00PM or 5:00PM) as well as in Money Exchange Offices. • It is recommended to come to Costa Rica with US dollars, since it is the reference Exchange rate for the country. Commercial banks in Costa Rica will only Exchange US dollars. Other foreign currencies such as the Euro tend to be more complicated and require a trip to the Central Bank of Costa Rica. • International credit cards: The use of credit cards such as a Master Card or Visa is common and there are no problems with using these in Costa Rica. Most cities have ATM’s. • Tips: There is no need to tip in restaurants as a 10% tip is included in your bill plus a 13% sales tax. However, you can add a 5-10% for exceptional service. You should tip a dollar per bag to those who carry your suitcases and you should leave between $1 and $5 per night to the cleaning staff .

In the mountainous region of the Atlantic, at an elevation of 800 to 1500 meters above sea level, the vegetation is characteristic of a rainforest. On the Central Plateau, it is dry and fewer trees grow there, but there is a proliferation of grass and herbaceous plants. In the higher elevations, one finds the mixed tropical forest.

Airports The Juan Santamaría International Airport is the main airport in Costa Rica. It is located in the Province of Alajuela, 18 Km outside the city of San José. The airport is named after Juan Santamaría, a Costa Rican national hero due to his participation in the national campaign of 18561857 against the Filibuster William Walker.

Costa Rica is extraordinarily blessed with fauna. The numbers and diversity of animal species found here is incredible. Depending on where you go, you have the possibility of observing Quetzals, 5 or 6 species de toucans, tapirs, deer, ant eaters, sloths, monkeys, white nosed coatis, otters, opossums, jaguars, ocelots, pumas, mountain lions, macaws and many more.

The airport has won several prizes such as third best airport within its category and fourth best airport in America in general category.

Beyond the above mentioned species, the wilderness is the home to nearly 13,000 species of plants, more than 2,000 species of butterflies, 4,500 species of moths, 163 species of amphibians, 220 species of reptiles, 1,600 species of freshwater and salt water fish and 850 species of birds and more. Money The Costa Rican Colon is the legal currency of the 36


Migration

The Daniel Oduber Quiros International Airport, also known as the Liberia International Airport, is one of the four international airports in Costa Rica. This airport is located in the northeast part of Costa Rica in Liberia, the capital of Guanacaste Province. It is about 217Km northeast of the capital San Jose and it works mainly as a focal point for the growing number of tourists who come to enjoy the excellent climate and grandiose beaches found in the Nicoya Peninsula. The arrival to the Liberia International Airport is the fastest way to reach places such as Tamarindo, Playa Negra, Golfo de Papagayo, Mal País, Playa Flamingo, Playa Samara and the Baulas National Marine Park.

If you wish to come to Costa Rica you must have a Passport that is valid for at least six months beyond your expected stay. The entry requirements are: •A Passport valid for 6 months upon entering the country •Return ticket

COSTA RICA OFFERS Sun and Beach One of the greatest attractions Costa Rica has is the large variety of beautiful beaches with white sand and crystal clear waters. Many of these are visited by thousands of people each year who are looking for a place to find fun and recreation. Its coasts offer a place to enjoy the sun and waves, to relax and to escape from stress of everyday life. (Important note: Not all the beaches have white sand and crystal clear waters. The Caribbean stands out for its variety of aquatic ecosystems and its sand beaches, of both black and white. They are ideal for activities focused on nature and sea such as sport fishing and diving in clear waters, as well as enjoying the sun and walking on the water’s edge on the beach.

The Airport was named in honor of a prior President of Costa Rica (1974-1978), Daniel Oduber Quirós. It was his idea to build this airport in this region and he was also a strong proponent of expansion and development of Guanacaste. This international airport was inaugurated in 1995 with a commercial flight from Miami, Florida.

The Pacific coast concentrates big tourist centers and its beaches are preferred for surfing.

• Taxi from the airport to San José: US$12-$17

Geographically, the Caribbean coastline of the country is 212 kilometers long going from Punta Castilla in the mouth of the San Juan River (on the northern border) to the mouth of the Sixaola River (on the southern border).

• Buses Alajuela-San José (5am-10pm) these stop at the airport every half-hour. • Exit tax: US$26.00

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The Pacific Coastline runs 1,016 kilometers from Mojones (on the northern border) to the Burica Milestone (on the southern border).

Guanacaste is famous for its spectacular beaches along 200 kilometers of coastline. The beaches in Guanacaste are blessed with a good wheather and crystal clear waters. Fishing, swimming, diving, surfing or just sun bathing are some of the many things that tourists can do. Visitors can also eat some of what the sea to offer recently has caught by local fishermen to be enjoyed under a starlit sky or simply for lunch with a comforting breeze as a backdrop.

Along those 1,228 kilometers of coastline, one can find some of the most splendid coral formations and anemones found in Central America while being in close contact with the ever dominant presence of the nearby jungle. There are three divisions that Costa Ricans fairly strictly apply to their beaches on the Pacific: North Pacific, Central Pacific and South Pacific.

The beaches in Guanacaste are ideal for surfing. Furthermore, they are one of the five best known surf sites in the world. Sport fishing in the high seas is also excellent and there are yearly sport fishing contests here. Most of the beaches in Guanacaste have white sand and dense vegetation. Some of the beaches are ancestral turtle spawning sites. It is said that Guanacaste has so many beaches that one could be surprised by so many.

The landscape starts on the northern end of the country on the Pacific side, with the sight of a semicircular bay called BahĂ­a de Salinas. This bay opens up into extensive beaches covered in pearl grey sands. This area is one of the best known places for sport fishing. From this point southward, one can find over 100 beaches along the coastline that vary in shape, color, type of sand, water temperature and landscapes, making them the best in Central America.

An important tourist attraction that has moved both national and international tourists is the city of Puntarenas. It still maintains its attraction for tourists: the Old Puntarenas is still the largest port on the Pacific side and from there the tourist can get many rides to the most pleasant and remote beaches that lie within the large Nicoya Gulf.

It must be highlighted that the beaches on Pacific Coast of Costa Rica offers to the tourist the greatest number hotels and infrastructure that, without being necessarily right on the beach like in other parts of the world, are found within minutes of the beach to maintain its wild and untouched character. Comfortable hotels and give the tourist sunny beaches often bordered by mangroves and rivers of incredible beauty including some that are true sanctuaries for tropical flora and fauna of the area.

Puntarenas is a city dedicated to tourism and fishing. Most of the coastal infrastructure for tourists is located here. Geographically and from the air, it appears to be an extended finger that deepens the sea and the estuary that surrounds it from the north.

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southward along the rest of the Caribbean coast of Central America.

Central Pacific

For those who love to dive, the floor of the coral reef is ideal. Its transparent waters allow one to grasp in one glance a myriad of anemones, kelp forests and schools of fish with incredible colors, all sorts of shapes and all the known species found in the Caribbean waters.

It should be highlighted that in the Central Pacific Manuel Antonio area it is not clear if the beach dominates the jungle or vice versa. It is located near Quepos Port in the so-called coastal strip of the South Pacific.

With the typical scene of the sunken ships from the seventeenth century deep in its waters, not only then reef dominates the area, but also the deep thick green jungle on the Atlantic side that covers the coastlines of Parismina, Matina, Pacuare and Tortuguero in the northern Caribbean. To go to the beaches of this wild rainforest coastline area, one must go by boats that leave from Puerto Limón. Cruise ships often use the artificial canals, lakes, rivers and estuaries along the 112 kilometers of waterways that connect Limon (the main port on the Atlantic side) with the outlying town known as “Barra del Colorado”, found in the northeastern part of the country.

The jungle here literally hangs over the sandy beaches and the tourist is astonished to find very large groups of Squirrel monkeys scurrying across the lower branches. These are some of the most attractive monkeys of the monkey family.

Ecotourism

Many foreigners have visited here and some have been so attracted to it that they have decided to stay forever in this paradise.

Thanks to the biodiversity found in the territory, Costa Rica is one of the top nature destinations of the world. It becomes a Mecca for hundreds of tourists who love our natural treasures and the fact that we are a leader in responsible ecotourism.

For those who want to venture to less traditional places, the country offers them unique opportunities to find the perfect landscape. South Pacific These are all coastal lands in the Southern Pacific. From Carate to Pavones the neighboring forests and some geographical landforms lend themselves to produce abundant alluvial gold. For hundreds of years gold prospectors combed every millimeter of these areas looking for the prized gold nuggets. Legend has it that there were some people who hit it big. Is this coast you will find at Pavones beach, one of the longest lefts in the world, great for surfers.

Ecotourism occurs when we make the least impact on our environment. It is an important source of income for the country. These very funds help protect natural environments as well as to benefit the local people by helping them to become less dependent on other activities that would be harmful to nature.

Caribe Costa Rica also has beaches on its Atlantic Coast that are very beautiful such as Cahuita, south of Limón. Cahuita is further known for being the place from which the corral reef extends itself 39


sightseeing and biologists.

Fortunately, Costa Rica is where much of the ecotourism was first started and it is where this activity has taken hold successfully. This natural paradise has broad experience showing off its marvelous natural resources to tens of thousands of visitors each year.

The cool wheather and fresh air makes it a favorite area for Honeymooners as well. Some of the most amazing Cloud Forests in Costa Rica are: Monteverde, Savegre Valley, San Gerardo de Dota, Poas, Barva, Turrialba, Talamanca Chirripo and many areas of the Tilaran Mountain Range and the Guanacaste Mountain Range.

A large percentage of tourists who visit Costa Rica are motivated by ecotourism while also participating in complementary activities. According to surveys of air passengers made by the Costa Rican Tourism Board, 61% of these passengers visit a national park while here, 66% observe the flora and fauna, and 65% use a nature trail. However, even more visitors (78%) visit a beach. Costa Rica is not only attractive because of its biodiversity but also for their good practices in ecotourism. The fact that in a period of only seven to fifteen days a person can experience two or three habitats, visit a volcano, stay in a city, go rafting, rest on a beach, participate in ecotourism activities, do regular tourism, participate in the lives of the people in rural areas, or choose activities that are adventurous, makes Costa Rica a great country to visit.

The Tropical Rainforest of Costa Rica In Costa Rica, almost all the lower parts of the Caribbean and the South Pacific are or they were some time covered completely by the rainy tropical forest. Nowadays, there are large extensions of this type of forest in the Caribbean in the South Pacific, as well as parts of the Central Pacific.o

The Cloud Forest of Costa Rica The Cloud Forest is located 1600 meters above sea level. Given the height, the trees do not grow as much as in coastal areas where tropical rain forests and dry tropical forests grow among others.

It is characterized for trees of great size, grove forest, rich biodiversity in both flora and fauna and by being one of the most important attractions of the country. The tropical forest of National Park Corcovado, it s said that is the richest in the world. Some of the most famous of rainforest are: Corcovado y Osa,Golfo Dulce and Golfito,Talamanca and some zones of the Coastal Row. In the Caribbean, the most important zones are: Gandoca and Puerto Viejo in the South Caribbean, Fila Carbón, Cahuita, Talamanca, Tortuguero, Barra del Colorado. In San Carlos: Boca Tapada and Cutris of San Carlos, Laderas North-East of the Cordillera of Tilarán and Guanacaste.

Costa Rica’s highlands have some of the world’s richest Cloud Forests. These amazing habitats are home to thousand of unique species of flora and fauna, some of them endemic, meaning they only exist in certain areas. The Cloud Forest is also unique scenery for hikers, birdwatchers, 40


The Tropical Dry Forest of Costa Rica

there is not tea mangrove. Inside both coasts, at times, you can see inside the mangrove swamp Forest: ferns, orchids and bromelias epĂ­fitas in the own trees of the mangrove. The destruction of the mangrove swamps in Costa Rica is due mainly to tourist projects in the beaches or by the development of the agriculture that always changes the nature of the surrounding marine ecosystem.

Tropical dry forests are forests that grow in areas that do not receive rain during many months of the year. In the dry forests of the Area of Conservation Guanacaste, there is a well definite dry season, during 6 months between the middle of December and the middle of May. Many trees in this time are without leaves. During the other 6 months of the year, there is a lot of rain. The forest is very wet and humid and all the plants have leaves and everything is green.

Adventure For lovers of adventure tourism, Costa Rica is a destination with an abundance of emotions and adrenaline. Some tourists prefer adventures with lots of action whether on land or water. They want to experience the wonders of this country by practicing their favorite sport. Throughout the year and in most of the country, whether by water, land or air you can choose from a wide variety of activities for the whole family that occur in natural settings where you can live memorable experiences.

Just like the tropical rainy forests, the tropical dry forests have a lot species of animals, plants, mushrooms, bacteria, and virus. Also, the people in the ACG are realizing that many tropical species are now living part of their lives in rainy or cloudy forests and live part of their lives in the dry forests. Therefore, it is important to preserve areas of dry forests and rain forest combined. ACG areas where there are no longer dry forest, or only very young forests, people in the ACG regenerated from pastures and old farms by controlling the fires of the dry season, caused by other people. Without fires, the forest grows. The Mangroves of Costa Rica There are ten wetlands in Costa Rica that have been declared as Wetlands of International Importance. Three of these are categorized as wildlife refuges and other is a national park. Once the country received the international recognition, it pledged to increase on its conservation and sustainable use.

Safety is the most important part when enjoying adventurous activities. For this reason, Costa Rica requires activities that they must be regulated and that those who provide the services obtain permits from several different governmental entities. If you are going to try one of these activities, ask your provider to prove you that they are in compliance with all the requirements to guarantee your safety. Because of the excellent quality that adventure tourism in Costa Rica has demonstrated, several international entities have distinguished our country as the best destination for adventure. One of the most popular activities among those who visit Costa Rica is diving as well as snorkeling. The person will come in contact with a colorful underwater world where one can watch the

In the Pacific Coast of Costa Rica you can see the red mangrove, the tea mangrove, the black mangroves, the white mangrove and seldom the mangrove botoncillo. In the Atlantic Coast 41


spectacular whales, sharks, white tip sharks (in Coco’s Island), stingrays, schools of different species, eels, lobsters, beautiful coral formations and many more.

• Canopy: This is traveling between two platforms that are usually located at the tops of the trees, while going at different speeds in a harness and holding on to a steel cable. During your ride sometimes you will cross river canyons for which it will be necessary to climb the mountain higher up to be able to continue. From the heights of the platforms and throughout your journey, you will be able to appreciate breathtaking landscapes and views of the forest from above. The advantage of the canopy is it can be enjoyed by everyone and it can be tempered to the level of adventure that each one wishes to try.

Coco’s Island is one of the ten most important marine places in the world. It was declared a Natural Heritage Site of Humanity by UNESCO in 1997. For this reason, visits to this island are controlled by SINAC- MINAE, the government agency responsible for the environment. The island is located 500km from Puntarenas and it takes approximately 20 hours to get there by boat. Land Activities: • Walks: To have a closer contact with nature, you will discover stunning mountain trails that invite you to penetrate into the beautiful corners of the country and to appreciate majestic rivers and waterfalls. • Mountain Biking: Beautiful landscapes, bold and fun trails await those who love to mountain bike. • Horseback Riding: You can enjoy horseback riding throughout most of the country with excellent guides. You can explore different paths through the forests, beaches and waterfalls or live an experience in harmony with the local community while discovering interesting people and sharing with immersion into the Costa Rican way of life.

• Bungee Jumping: Enjoy the adrenaline rush as you defy vertigo by falling freely through the air and bouncing back several times before coming to a stop. Bungee jumping has been practiced in Costa Rica since 1991. It is done on Bungee cords in several different places.

• Caving: Get to know the underground mysterious world of the caverns as you practice spelunking this will allow you to experience beauty from a completely different perspective while you practice an adventure sport that is not common and entails somewhat of a risk.

Water Activities • White Water Rafting down the rivers of Costa Rica: While you travel down our rapids and eddies, you will enjoy a natural world around you. If you prefer to go to more calm waters that can be also arranged. You will be able to see better the environment and you will be able to admire the wild animals and exuberant forests that will beckon you to become one with them.

• Hanging Bridges: Be adventurous some as you get on some of these incredible structures of hanging bridges. The entire family can get up close and personal with scenic rivers, the forest canopy and the sensation of depth while seeing how life exists on the tops of the trees.

• Surfing: Costa Rica is the perfect place for surfers. The point breaks, beach breaks and perfect lefts and rights found here all make this tiny Central American country a leading surfer hotspot in the world today. Its beaches are usually very clean, pristine and rarely crowded. Costa Rica has definitely become a favorite hangout for surfers, specially for those

• Rappel: This is an exercise where you will descend from the top of a tall tree, a waterfall, a Cliff or other rocky formation to the ground. The only thing needed is comfortable clothing and choose the best “tour” for you to fulfill your adventure needs. 42


• Kayaking: You can also enjoy kayaking in our oceans, where you will experience the exciting movement of their waves under the radiant sun and you will be able to see the wonderful beaches of Costa Rica with their multicolored sands surrounded by exuberant vegetation. You can also enjoy relaxing canoe/kayak trips down our rivers, canals, lakes and wetlands surrounded by nature and its exquisite beauty.

who would like to try out some of the most challenging waves on the planet.

• Snorkeling/Diving: Diving is one of the activities that attract most the tourists who visit Costa Rica. Snorkeling is also greatly sought after. There are many places along both coasts that these activities can be enjoyed. Good diving areas are: Cocos Island and Caño Island. Good snorkeling areas are: Caño Island, Ballena Marine National Park .

Costa Rica has well over 50 famous surf breaks along its shoreline. Legendary and truly spectacular, the waves here are big and with the many reef breaks found along the coast surfers here are in for hollow and fast rides. Though some of the surfer beaches maybe kind of hard to reach due to poor road conditions, they are well worth the trip as the waves are good all year round. Some breaks like Pavones have the longest rides in the world and is definitely worth the long trek to get there. Major swells can be found on the Costa Rican coast between the months of April and October, but it is from December to April that the surf is at its cleanest. While the top five surf destinations are at Playa Hermosa, Playa Grande, Pavones, Witches Rock and Salsa Brava, some other popular surf points in Costa Rica are Dominical, Santa Teresa/Mal País, Playa Negra, Playa Junquillal and Playa Avellana. The surf at Playa Naranjo or Witches Rock is also very good with many surf scenes from the movie Endless Summer II having been filmed here.

Family Fun World tourism has given a lot of importance to satisfy the growing demand for family vacation time. The principles of peace and democracy which Costa Rica has espoused throughout its history, naturally lend themselves to develop a series of activities and places with programs that specialize in family recreation: hiking, guided tours, group games, interaction with diverse communities and cultural groups, beach sports and others. There are also opportunities to sample the varied number of Costa Rican dishes. You can choose from many different activities to enjoy with your loved ones enthusiastically during your free time. Sports, adventures, nature, relaxation – all are a part of family tourism that you can experience here in Costa Rica. 43


Culture Costa Rica has a proud culture with a lot to offer to those who would like to discover it. Its richness lies in the cultural diversity of its people. All through history, on top of the indigenous population that was here prior to the Spanish Conquest, the country has supported waves of immigrants that have come down to settle here. Costa Rica received its first printing press in 1830. In the first part of the twentieth century its literature has given us beautiful writings depicting our customs, unique essayists and writers. To be highlighted are the social novels of Carlos Luis Fallas and most recently great modern poets.

Likewise, beyond the mestizo majority, there are various national ethnic groups as well as immigrant groups who claim their own particular cultural heritage such as those of African descent, Chinese, Hebrews, Lebanese, Italians, etc. The Indian Tribes include the Bribri, the Cabécar, the Maleku, the Teribe, the Boruca, the Ngöbe, the Huetar and the Chorotega.

The painters that found nationalism left a deep imprint on regional esthetics. The jump to and accelerated modernization was given by Francisco Amighetti and his generation. Furthermore, Costa Rica has had famous portrait painters such as Enrique Echandi, Gonzalo Morales Alvarado and Gonzalo Morales Suárez. Other landscape artists that are well known in Costa Rica are Rodolfo Stanley, Fernando Carballo and Rafa Fernández.

Costa Ricans are proud to have a democratic tradition of over 50 years without an army. It was abolished in 1948 and the Money that was saved is invested in improving the standard of living of its inhabitants. This results in social peace and makes Costa Rica a pleasant place to visit.

Once the Youth Symphony Orchestra was formed, many vocations flowed. This resulted in the current National Symphony Orchestra. Dance is also one of the most popular disciplines and theater has been going strong for the past 30 years. Today, Costa Rica has a great number of artistic venues that include music, dance, theater, cinema and television productions, visual arts and literature.

The “ticos”, as Costa Ricans are also known, are famous for their hospitality and they like to keep this reputation. They are well educated and hard workers. They like to smile at people and to shake hands. They know their land is special. They usually will happily help a visitor who is lost, taking the time to explain things that the visitor may find strange. They will try to make the visitor’s stay as pleasant as possible. It is often said that the ticos are the countrie’s best asset and once you have experienced their friendliness and spontaneity you will have no doubt that this is true.

Honeymoon Costa Rica is the perfect place for lovers! It offers an exotic ambient, captivating solitary beaches and a romantic way of being.

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easily reached by car or by air in order to make your honeymoon unique and fascinating. The major locations for mountain hotels are found in: Monteverde, Llanuras del Norte (Northern Plains), Valle Central (Central Valley), Caribe Norte (North Caribbean), South Pacific and Central Pacific.

There are hotels specialized in honeymoons that will make you feel special at this time. You will find many options to choose from – there is something special here for every different taste and budget. There are also boutique hotels that offer greater privacy. These can be found near beaches, some with an all inclusive package; other can be found in the mountains that allow you to enjoy that environment as well.

The place you choose for your honeymoon should have a warm and intimate ambient; it should be different and some what unforgettable. This is a special experience for both of you that will become a memory special forever.

The number of options found in Costa Rica for this special time of your life will complement the love and mystical magic of your union. Here you can walk alone together in natural surroundings. Hide in the mist, observe the tropical flora and fauna of the tropical forests or listen to the rain while you embrace under the roof of your cabin.

Costa Rica is a paradise where you will be in contact with nature and with beautiful scenery. You can enjoy tranquility or adventures filled with emotions at the beach or surrounded by exotic forests.

Health Tourism

You will also have the opportunity to enjoy other activities such as horseback riding, breathing the fragrance of the forests while hiking, or feeling the excitement and adrenaline of activities such as rafting, cable car rides or zip lining through the tree tops.

The Ministries of Tourism, Competitiveness, and Foreign Trade Health of Costa Rica signed a decree declaring Health Tourism as being “of public interest”. The health rates in Costa Rica, the quality of medical services and the low prices

Among the variety of places where you can spend these wonderful moments you can find mountains, volcanoes, waterfalls, jungles, tropical rainforests, lakes and many more. All of these are great places are close enough that they can be

for these services, compared to other places, has made Costa Rica one of the most coveted destinations for medical tourism.

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At the cities around the world the level of stress grows daily. For this reason, one must look for ways to get away from it. Costa Rica, a home for so many natural paradises, has been able to create the perfect combination between these environments and adequate infrastructure to offer health tourism.

sought after by many foreigners in this country as there is a group of highly qualified plastic surgeons here. Each year more and more of these treatments take place here and vary from the simplest procedures such as a small scar repair, to the most sophisticated treatments that can change a person’s quality of life, overall health as well as the person’s self.

You can give yourself the great opportunity of being able to rest in beautiful places, where the food, activities and esthetic treatments are here to make you have a relaxing holiday while improving your quality of life. All these elements will help you avoid tension, muscle pains, fatigue, migraines and reduce the signs of aging, that you feel better about yourself.

A discussion with one of our surgeons will put you at ease and help you realize in the great hands you are and the many options available to you. Whether you need implants, prostheses, orthodontics, cardiovascular, gastroenterological, orthopedic or other specialty care – you will find it far less expensive here without reducing your expectation of the quality care you would expect back home.

There is no doubt that Costa Rica has health indices as high as those found in developed countries even though we do not have the same financial resources as these. Some of the best plastic surgeons in the world are found in Costa Rica. Even though this is a small country, health is a high priority and it has attained the level of care found in the United States and other highly developed medical systems.

During your post-op time or while you are receiving treatments, you are accommodated at nearby hotels that cater your needs. Depending on your health status, you can use this recovery time to tour the city and its environments, since there are few restrictions placed on your activities. Costa Rica Tour offers transportation to and from hospitals and doctors’ offices as well as to and from the airport and your hotel.

San José, Costa Rica, has become a Mecca for highly qualified plastic and reconstructive surgeons as well as oral and ophthalmological surgeons.

While in Costa Rica, you can live in complete harmony with nature and your food. There are places that will be happy to offer you all organic food in delicious preparations. In these places, they use products that have gone under strict quality control and organic certification.

Costa Rica has first class hospitals that cover all the medical specialties. Patients are protected by adequate legislation, and this makes Costa Rica a very attractive place to come, if you are looking for high quality medical care. Health tourism has become a very important part of tourism in Costa Rica. Spas, resorts, recovery centers, clinics, plastic and aesthetic surgical stand clinics as well as health centers abound in Costa Rica. It is also easy to find hotels that specialize in health tourism here.

Furthermore, many hotels include attention to body and skin care to improve your body care. They may offer you gyms and other exercise options to improve your overall health. This movement of getting into a better physical shape is complement to the healthy weekend outings and the health related travel. There are

For many years plastic and cosmetic surgery were discover by many foreigners in this country because there is a group of highly qualified plastic surgeons here. Each year more and more of these treatments take place here and vary from simple procedures to more sophisticated treatments. Breast augmentation and breast reduction surgery, rejuvenation treatments, facial plastic surgery and many others are done with great success. For many years plastic and cosmetic surgery was 46


Rural Community Tourism consists of planned activities where tourists can experience community life by becoming pat of the local rural communities. These communities have organized their living space to be able to share their experience of living sustainably within their environment for the benefit of the whole community. (ICT, PNUD, TRC Alliance 2005)

also a large number of Spas that offer several relaxation treatments as well as those directed to improve your overall health appearance.

The six characteristics that define rural tourism are: • There is an integration of the natural resources and daily living in the rural community. • Sustainable production practices are maintained within what is offered to the tourists. • The tourism experience is adapted to the rural dynamics of the area, preserves it peculiarity and the rustic friendly and comfortable environment that characterizes rural life in Costa Rica.

Internationally, physical beauty for personal satisfaction has become an important topic. Costa Rica is part of this tendency by offering services that will make the visitor look and feel better. You deserve it! There are facial treatments, exfoliates, various modalities of massages as well as massage with volcanic mud and detoxification baths. Yoga and Pilates classes can be found too, and your health will be improved as you take advantage of the unique natural benefits of bathing in thermal waters or receiving skin treatments with products made from natural medicinal plants grown locally.

• It integrates the local people in this business, distributes benefits and supplements the income of rural families. • It promotes land tenure by the local people.

You will have access to excellent installations, highly trained practitioners and company services that specialize in arranging your treatment in specialty clinics with guaranteed international standards and highly regarded specialists, including those who work in plastic and esthetic treatments.

Rural Community Tourism Those who choose rural community tourism will participate in the lives of the local community and will feel more like guests in peoples’ homes than tourists. This is because the small rural hostels are not found in tourist center points, they are found in small rural communities, natural reserves or indigenous territories who have not altered their way of life in order to adapt to the needs of tourists. Some of the communities that offer this type of tourism have more than 10 years of experience. Because this offer comes from the efforts and 47


creativity of the rural people of Costa Rica, many operate in a very informal manner.

the hope of connecting Cahuita National Park with Gandoca Manzanillo Wildlife Refuge and La Amistad International.

The head organizations of rural tourism play a very important role in protecting forests, aquifers, and endangered species. With environmental educational campaigns, consciousness and empowerment to file formal complaints against those who would endanger wildlife, these people confront many threats to the environment.

With your visit to the rural communities you are contributing to complement their efforts. However, if are interested in learning more about the current initiatives or would like to collaborate with any one of them, do not hesitate to ask any of the organizations. Many of them have a volunteer program or ways in which you can become a permanent sponsor or be part of a campaign that seeks funds to buy more lands for conservation projects.

For example, ASEPALECO (the Ecological Association of Paquera, Lepanto and Cóbano) carries out an environmental task that is very important in the southern part of the Nocoya Peninsula. With the stimulus given by the Peninsular Biological Corridor, the organization has been able to: provide environmental education programs, create 32 mini-forests in the local schools, put into place the first ecological reutilization of solid waste in the country and they have also implemented a program to combat forest fires based on voluntary brigades. They also protect a private 800 hectare reserve called – the Karen Mogensen Reserve. The ABIPA Association (The Association of Agricultural Producers of Bijagua) manages the Heliconias Lodge and Rainforest and protects 400 hectares of forest. It gives English classes and environmental education to the community through a Coop made up of young people. At the same time, the Association promotes the strengthening of the women’s group that develops handicrafts for ABIPA.

The rural communities show you life as it is – with ‘no artificial ingredients’. Their culture is alive and as diverse as the landscapes found in Costa Rica. From the warm plains in Guanacaste or the exuberant beaches along the Caribbean coastline to the mountains covered in clouds along the Talamanca Mountain Range and the Cerro de la Muerte, we can find marked differences. However, regardless of these geographical differences, there is something in common – the warmth and simple hospitality that each visitor finds.

Thousands of hectares of forests are being protected in the form of communal reserves. These reserves are very important biological corridors bridges that connect wildlife areas promoting the interchange between species and facilitating the animals’ search for food and reproduction. The majority of the lodges and hostels in this Guide are located along these corridors. You will be able to trek through most of them by using a system of paths as well as lookout points and hanging bridges. The Talamanca Caribbean Biological Corridor is one of the many existing examples all along the country that this can be done. All the initiatives that are shown under the section of the South Caribbean are participating in these efforts. They are carrying out programs of environmental education, protecting the forests and participating in reforestation projects with

In San Antonio de Escazú, located in the Central Valley, there are green mountains, traditional sugar cane mills and carts ox that have become part of the daily scenery. However, they have survived only thanks to the efforts made by rural 48


community tourism, support obtained from CODECE (Environmental Activism) and the “El Encanto de la Piedra Blanca” – a rural community tourism site. Here, cultural traditions and the love for the mountains are always strengthened. Don Torino shows his traditional sugar cane mill with pride and the ability to make the “tapa de dulce” (a dried unrefined unbleached whole sugar cane product), Don Pedro, the mask maker, shows the visitor how to dance to the rhythm of the “cimarrona” (a group of musicians mostly using brass instruments with no particular musical training who get together to make music in the towns) as well as how to make a mask similar to those used in folk dances for popular celebrations. Through the Regulatory Plan of Escazú, the hills around it have been set aside as an outdoor recreation area where cement is not allowed.

a close coexistence and the possibility of dealing directly with the people who are your hosts. The richness of your experience will depend largely on your own attitude and it will be unique and unrepeatable. Do not be surprised if they ask you to share your customes with them as well. Many people will feel curious and will ask you about where you come from. Source: ACTUAR. Business Tourism and Incentives Costa Rica has the perfect ambiance for your business trip. An appropriate symbiosis infrastructure either in the city, the beach or in an other wonderful natural environment makes this a place where you can come with your work team and conduct your meetings with the appropriate performance. Its small size, its great variety of natural environments and its climate as well as all of its attractions, activities and excellent accommodations infrastructure makes Costa Rica a highly sought after destination for those who would organize such events. Furthermore, its ease t access by air to the main event centers, its hotels industry that can adapt to different budgets, the political stability and the security found here are all factors that play in helping you make your best decision. Add this to a tropical paradise and you have an excellent destination for all your meetings needs. Invitees and their families can accompany your group and also enjoy the rainforest, volcanoes, rivers, beaches and innumerable natural treasures filled with adventure. The options available to accompanying families are so many, once your work is finished, you will want to share some of these experiences with them and together enjoy the wonderful attractions that Costa Rica has to offer.

On the Caribbean side of the country, there is an indigenous community in Yorkín that shares its traditions inherited from its ancestors with each visitor. They share the procedure of manually extracting chocolate from the cacao seed all the way to making a hot cup of cocoa how to knit palm leaves together to make thatched roofs for their homes. They also give the visitor their vision of the world and they share their ancestral language - Bribri. In the Northern Zone, country life is enjoyed through the Jazón Association and its Vacations with Rural Community Families program. This type of tourism helps the visitor share in the daily lives of people in the rural areas. Here the simple daily chores are combined with the beauty of the natural surroundings and the cultural inheritance that has been kept alive. Take the necessary time to really get to know the authentic way of being a Tico. Rural Community Tourism does not package culture in post cards or shows designed for the tourist. What is offered is 49


The hotels industry here is prepared to offer excellent service to all your invitees. There are five star luxurious hotels, boutique hotels and many others where you will find the appropriate infrastructure whether you are holding a large conference meeting or offering incentive packages. There are Conference Centers with large meeting rooms for large events located mostly in the Central Valley that have a capacity of up to 2000 people. There are also many other options in other regions of the country as well.

Moreover, your activities do not have to end in a meeting room. There are several complementary services that will make your event a success. There are banquet services, special parties and celebrations, a variety of restaurants, handicrafts and good transportation all over Costa Rica. For those who specialize in Incentive Packages, prices are very competitive all year long. As an added incentive for companies and organizations from the United States, many of the major expenses are tax exempt when Costa Rica is the location of your meeting. To this you can add that you have the perfect tropical ambiance that offers its enormous natural inheritance. This results in you being able to count on an attractive destination of almost limitless markets that includes vast rainforests, volcanoes, rivers that wind down the mountains, a large number of beaches natural resources that are protected by a solid system of national parks and forest reserves, all kinds of environments that forms an unparalleled scenario that combines multiple opportunities for adventure in a wide range of tourist attractions. This translates to huge possibilities for any inventive travel organizer would like to carry out a magnificent tour program for any meeting.

Access to all these different places can easily be done by land or by air. There are direct flights from the United States and Canada, as well as from some other countries to Juan Santamaria International Airport in San Jose or the Daniel Oduber International Airport in Liberia allowing you to spend more of your time in what interests you the most. Telecommunications and technological equipment are indispensible in today’s business environment. In this aspect, Costa Rica has one of the most advanced telephone systems in Latin America. In this way all your business needs can appropriate be done and you will have the peace of mind that your Business transactions will go smoothly while you are here. During your Business meeting you will have all the Tools at your disposal.

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